Release and Indemnity Agreement (Read Carefully)

I, the undersigned parent/legal guardian of________________________, authorize said child's full participation in the Soccer Academy of Louisiana 6 v 6 Summer League. In consideration of my child's participation and the use of SAL facilities for soccer activities, I hereby release and agree to defend, indemnify and hold harmless Essie Amire, the Soccer Academy of Louisiana, it's Directors, Coaches and Officials, and the insurers of each, from any claim for injury or damage that might arise from my or my child's participation in soccer activities at the Soccer Academy of Louisiana; or while providing medical care to my child, including transportation to and from a medical facility; regardless of whether such injury and/or claim arises wholly or in part from the fault the above named persons/entities.
Camper's Name:___________________________________
Pesonal Insurance and No:________________________________________________
Physician Name:___________________________________
Parent/Guardian Signature:__________________________
Are you a registered soccer player with the Louisiana Soccer Association (LSA) or Lafayette Youth Soccer Association (LYSA), or any other soccer association, which is affiliated with LSA this 2006-07 season?
____Yes. I played soccer for (Name of the League)_____________________ during 20006-07.
_____No. I did not play soccer for any league during 2006-07.